The emotional resistance to admitting error cannot be legislated away

It’s been more than a decade since the seminal report “To Err is Human” by the Institute of Medicine. The report made waves when it estimated that 1.5 million people are affected by medical errors and that nearly 100,000 die annually as a result of medical errors. Some of those numbers have been debated, but there is no doubt that medical error is a significant issue in medicine that needs to be addressed.

Most errors are “systems errors,”— flaws in the system, such as a different medications in similar-looking packages. These errors are usually easier to identify and simpler to fix. Certainly the electronic medical record is making strides in minimizing error due to illegible handwriting, drug interactions, misplaced paper records, etc.

Error due to the individuals is less common but in much harder to address. Computers and electronic medical records can help us, but they have their limitations. The first step in dealing with individual error is convincing healthcare workers to come forward and admit errors when they occur. This is one of the biggest challenges in the field of error prevention.

Obviously the fear of lawsuits is an enormous deterrent. Most doctors — they are the ones who are sued the most — have a nearly reflexive fear of saying anything that might result in a malpractice suit. Increasingly, there is a recognition that we need legal protections for doctors who admit errors and apologize to patients, but that only addresses one part of the issue.

The emotional resistance to admitting error, the shame and guilt, are powerful barriers to owning up to error. These emotions cannot be legislated away. In a recent issue of Health Affairs, I write about a medical error I committed as a doctor-in-training. It has taken me nearly two decades to speak publicly about this because of how painful it was. However, speaking openly about our errors is the only way to teach the newer generation of doctors how to be honest about error.